Cohort of Medical Students Experience Bolivia and Peru

Global health experiences through the Office of Global Health Education (OGHE) are transformative learning opportunities that may include work in an international clinic or a globally-related research project. Academic excellence, experiential learning and a culturally rich atmosphere are the cornerstones of a vibrant global health experience. This summer, a cohort of medical students participated in global health experiences in Bolivia and Peru.

Bolivia: Reproductive and Sexual Health

This was the third year UNC students participated in the Bolivia: Reproductive and Sexual Health Program, working with CIES, a nonprofit organization that fills an important need for reproductive and sexual health care, as Bolivia has the highest teen pregnancy rate in the region. Students also studied Spanish intensively, through Latino Schools, before starting with CIES.

Kira Griffith spent four weeks in Bolivia, three of which were in Tarija, a city on the southern border of the country nearby Argentina.

“Growing up in the U.S. Virgin Islands, I’ve always had a passion for global health and a desire to understand how we can improve healthcare access. I chose Bolivia to learn more about their healthcare system, immerse myself in a new culture, and practice my medical Spanish. During my time in Tarija, I spent each morning, Monday through Friday, shadowing in the CIES clinic, a private clinic that focuses on reproductive and sexual healthcare across the country.

“In the afternoons, I participated in virtual Spanish classes. I also engaged in discussion with youth leaders to compare similarities and differences between healthcare education and access in the U.S. and Bolivia. Outside of Tarija, I traveled with a group of seven other UNC medical students to Sucre, Potosi, and Uyuni, to learn more about the history of colonialism, indigenous heritage, and modern-day livelihoods of Bolivian citizens.

“One of my most memorable experiences occurred while shadowing a radiologist during my last week in Tarija. We were performing an ultrasound for a young patient who had a positive pregnancy test. Ultrasound imaging can be challenging to interpret at baseline. It can be even more challenging to explain what we see to patients. However, I remember the joy in this patient’s eyes when, through our guided explanation, she was able to see the beating heart of her six-week fetus. This beautiful moment solidified my interest in pursuing a career as a radiologist.”

Youth Helping Youth

Anu Chaparala traveled to the city of Sucre, in Bolivia, to experience the CIES clinic network and their mission to provide affordable access to sexual and reproductive health education to the young people of Bolivia. One highlight was connecting with youth in a program called “Programa de Jóvenes.” Each Saturday, youth 13 and older met to discuss sexual and reproductive health in a program that empowers Bolivia’s youth to take control of their sexual and reproductive health, to help them navigate threats to their health and wellbeing as they enter young adulthood, such as sexually transmitted infections, urogenital cancers, and sexual violence. After learning about these topics, youth go out to local plazas and parks to disseminate information, to spread the word about resources that are available to help young people.

“For me personally, I really enjoyed sitting in on these meetings and being a part of this public health initiative. Information truly is power, and educating young people about topics such as this is the best way to support the growth and wellness of youth as they transition into the adult world. With this information and sharing of personal experiences, I feel that all of the youth leaders were informed to a degree that enabled them to advocate for themselves and others alike. These meetings fostered a strong sense of community and peer support, in a judgement-free and safe environment, which is critical when trying to openly discuss topics of sexual and reproductive health. Overall, Programa de Jóvenes is a brilliant social initiative that aims to destigmatizes sexual and reproductive health, creating a space for open conversation to empower the youth of Bolivia.”

With her UNC School of Medicine cohort, Chaparala also got to explore Sucre, and visit the salt flats of Uyuni and mine of Potosi.

Peru: Serving Rural Communities

James Petrongelli and Elyssa Alvarez both traveled to Cusco, Peru. They described Cusco as having many rural regions which presented the opportunity to see patients from rural and tribal communities, to observe gaps and strengths within the healthcare system.

“When I approached OGHE about opportunities, they mentioned a trip to Peru, and I knew I had to apply,” Petrongelli said. “I spent the first two weeks here in language school, exclusively, then spent the next four weeks shadowing in several clinics while attending Spanish classes in the afternoon. I volunteered at a clinic and two hospitals and was able to speak with physicians about their experiences in medicine. I also assisted in basic translations with English speakers, performed physical exams, and observed several surgeries. 

“There are a wide health disparities in Peru, particularly in the Cusco area, due to the remoteness of certain pueblos. Medical training for nurses, technicians, and physicians includes a year of work in these remote areas, encouraging medical personnel to understand the intricacies of rural health demands. This training requires knowledge of herbs and traditional medicines. The government also deploys mobile health units that travel by boat, plane, and on foot to these regions, providing vaccinations, maternal care, and general medical consultations.

The people of Cusco rely heavily on their collective community identity despite governmental issues. When I was sick or feeling unwell, my host mother or even strangers had suggestions for herbal teas or home remedies to help. I truly felt connected to the people here.”

Elyssa Alvarez visited Cusco, Peru, for a month, rotating between a private health clinic that serves mostly travelers and Peruvians with health insurance, and a public hospital that serves those residing within the region of Cusco, as well as any individuals lacking health insurance or resources. She chose Cusco to be able to explore global systems of health and diseases endemic to South America, and to serve Latino populations. 

“One thing I learned while rotating in the public hospital is that physicians are required to know Quechua within the region of Cusco,” Alvarez said. “However, despite this, their medical staff does not have the same requirement and translators and interpreters unfortunately do not exist within their medical system. I observed the consequence of this fault in their medical system – a lack of efficient patient care and respect towards the patient.

“This cultural gap alongside the barrier in languages presents difficulties when combined with an overwhelming lack of resources and a harmful mentality that resides amongst some providers towards the indigenous people of Cusco, ultimately resulting in subpar communication, and an overall poorer quality of patient care. This experience has provided me with a more logistical way of viewing global health efforts, as well as has shaped the ways in which I would like to see myself contribute to improving health outcomes throughout my career.

“My rotation in the public hospital was eye opening in many ways, including the opportunity to see infectious diseases influenced by living conditions that would normally be uncommon to see within the U.S., including leishmaniasis, schistosomiasis, malaria, cysticercosis, and parasites that create cysts within the liver and lungs. In addition, I learned much about homeopathic medicine during my rotations. Because the hospital I rotated at is a contingency hospital, it is truly resource deficient and relies on a mix of modern medicine and naturalistic remedies to provide patient care. Because of the populations they serve, different health care strategies were used to care for these populations, including the use of herbal treatments of Amazonian plants and local flora, and the prescriptions of teas/infusions to take alongside medications to manage chronic conditions or aid in the facilitation of treatments.

“My roles in these clinics ranged from assisting providers to observing surgeries and conducting patient consultations. From basic wound care and taking histories and conducting physical exams to assisting with the birthing process, my time in Cusco was chalk full of experiences that helped my professional growth, interests, and career goals.”

“Everything about my experience in Cusco was memorable, both inside and outside of the clinic! From the breathtaking landscapes to my host family and the wonderful people who I met throughout my time there; it was an unforgettable experience! I was met with many physical and health challenges in Cusco, including struggling with control over my asthma due to the altitude. In addition, I had contracted bronchitis, Giardia, and salmonella.”

“Despite this, the experience has wholly changed my life perspective and personal goals, having literally conquered mountains and trails that only in my wildest dreams I could have completed. However, what sticks with me the most is the beautiful culture of their land and people that the cuzqueños shared with me throughout my month living there.”

The Office of Global Health Education through the UNC Institute for Global Health and Infectious Diseases and with support from the UNC School of Medicine, seeks to foster collaboration and cooperation with broader initiatives in global health and education at UNC, including the Office of Global Health in the UNC Gillings School of Global Public Health, UNC Global, and the UNC Center for Global Initiatives.